11] Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy  Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
21] Department of Health Sciences, Centre of Biostatistics for Clinical Epidemiology, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, Italy  Department of Epidemiology, IRCCS Mario Negri Institute for Pharmacological Research, Via La Masa 19, 20156 Milan, Italy.
3Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
4Neurology, Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy.
51] The Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574, USA  Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Science, Kargar Shomali Ave, 14117-13135 Tehran, I.R. Iran  Surveillance and Health Services Research, American Cancer Society, 250 Williams Street, Atlanta, GA 30303, USA.
6Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, 1518 Clifton Road, N.E., Atlanta, GA 30322, USA.
7Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy.
8Nutritional Epidemiology Group, International Agency for Research on Cancer, 150 Cours Albert-Thomas, 69008 Lyon, France.
91] Department of Epidemiology, IRCCS Mario Negri Institute for Pharmacological Research, Via La Masa 19, 20156 Milan, Italy  Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Via Vanzetti, 5 - 20133 Milan, Italy.
10Department of Epidemiology, IRCCS Mario Negri Institute for Pharmacological Research, Via La Masa 19, 20156 Milan, Italy.
111] Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Via Bicocca degli Arcimboldi 8, 20126 Milan, Italy  Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, Stockholm 171 77, Sweden.
12The Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574, USA.
13Department of Clinical Sciences and Community Health, University of Milan, Via Vanzetti, 5 - 20133 Milan, Italy.
Background:Alcohol is a risk factor for cancer of the oral cavity, pharynx, oesophagus, colorectum, liver, larynx and female breast, whereas its impact on other cancers remains controversial.Methods:We investigated the effect of alcohol on 23 cancer types through a meta-analytic approach. We used dose-response meta-regression models and investigated potential sources of heterogeneity.Results:A total of 572 studies, including 486 538 cancer cases, were identified. Relative risks (RRs) for heavy drinkers compared with nondrinkers and occasional drinkers were 5.13 for oral and pharyngeal cancer, 4.95 for oesophageal squamous cell carcinoma, 1.44 for colorectal, 2.65 for laryngeal and 1.61 for breast cancer; for thoseneoplasms there was a clear dose-risk relationship. Heavy drinkers also had a significantly higher risk of cancer of the stomach (RR 1.21), liver (2.07), gallbladder (2.64), pancreas (1.19) and lung (1.15). There was indication of a positive association between alcohol consumption and risk of melanoma and prostate cancer. Alcohol consumption and risk of Hodgkin's and Non-Hodgkin's lymphomas were inversely associated.Conclusions:Alcohol increases risk of cancer of oral cavity and pharynx, oesophagus, colorectum, liver, larynx and female breast. There is accumulating evidence that alcohol drinking is associated with some other cancers such as pancreas and prostate cancer and melanoma.
1Laboratory of Toxicology, College of Veterinary Medicine, Research Institute for Veterinary Science, and BK21 PLUS Program for Creative Veterinary Science Research, Seoul National University , Seoul 151-742 , South Korea +82 2 880 1276 ; firstname.lastname@example.org.
Introduction: Lung cancer has the highest mortality rate among all cancers in both men and women. Aerosol delivery is a noninvasive method for gene delivery to the lungs, although efficient and biocompatible vectors need to be developed for lung cancer therapy.
Areas covered: This review summarizes recent advances in airway gene delivery for lung cancer treatment in animal models using viral vectors or cationic polymers. Viral vectors including lentiviruses and adenoviruses have been used for airway gene delivery because of their high transfection efficiency. Cationic polymers have also been developed for aerosol gene therapy owing to their biocompatibility and ease of modification.
Expert opinion: Efficient delivery and specific promoters are needed for lung cancer therapy. Capsid engineering or PEGylation can lower immunogenicity. Moreover, immunotherapy and oncolytic viruses need to be tested with aerosol delivery for lung cancer therapy. Meanwhile, naturally existing cationic materials may allow the development of novel and biocompatible carriers. In combination with various technologies for aerosol delivery, novel and specific carriers could be developed for lung cancer therapy in the future. Finally, standardized protocols for quantifying and manufacturing viral vectors and cationic polymers need to be developed in order to ensure biosafety.
1National Association of County & City Health Officials, Washington, District of Columbia (Dr Hearne and Ms Bass); de Beaumont Foundation, Bethesda, Maryland (Mr Castrucci and Dr Leider); and Robert Wood Johnson Foundation, Princeton, New Jersey (Dr Russo).
More than 2800 local health departments (LHDs) provide public health services to more than 300 million individuals in the United States. This study focuses on departments serving the most populous districts in the nation, including the members of the Big Cities Health Coalition (BCHC) in 2013.
To systematically gather leadership perspectives on the most pressing issues facing large, urban health departments. In addition, to quantify variation in policy involvement between BCHC LHDs and other LHDs.
We used a parallel mixed-methods approach, including interviews with 45 leaders from the BCHC departments, together with secondary data analysis of the National Association of County & City Health Officials' (NACCHO) 2013 Profile data.
Forty-five local health officials, chiefs of policy, and chief science/medical officers from 16 BCHC LHDs.
The BCHC departments are more actively involved in policy at the state and federal levels than are other LHDs. All BCHC members participated in at least 1 of the 5 policy areas that NACCHO tracks at the local level, 89% at the state level, and 74% at the federal level. Comparatively, overall 81% of all LHDs participated in any of the 5 areas at the local level, 57% at the state level, and 15% at the federal level. The BCHC leaders identified barriers they face in their work, including insufficient funding, political challenges, bureaucracy, lack of understanding of issues by key decision makers, and workforce competency.
As more people in the United States are living in metropolitan areas, large, urban health departments are playing increasingly important roles in protecting and promoting public health. The BCHC LHDs are active in policy change to improve health, but are limited by insufficient funding, governmental bureaucracy, and workforce development challenges.
1a Bioethics Institute Ghent, Department of Philosophy , Ghent University , Ghent , Belgium.
In this qualitative study, we explore how lesbian recipients view and experience the selection of their anonymous sperm donor. The study was conducted in Belgium, where fertility centres follow a legal protocol that severely restricts personal choice in donor selection. While previous studies have shown that recipients want greater control and input in the selection of their sperm donor, this was not a main concern for most women in the present study. They generally acknowledged their lack of control on the selection outcome and accepted this as part and parcel of an anonymous donation policy that provides an opportunity to have a child. They actively and passively downplayed initial concerns about the donor selection procedure and felt they did not have or need a right to further control over the donor selection. In adopting this 'subordinate' position, they felt they should trust the hospital, which they hoped would fulfil rather high screening standards. Those who did want more choice were nuanced and careful about their motivations: they focused on selecting traits that would facilitate normal child development or increase family coherence. The findings shed light on how these patients perceive their position in this third-party reproduction setting.
1Human Pharmacology Unit, Hospital del Mar Medical Research Institute-IMIM, Barcelona, Spain; Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain.
2Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
3Human Pharmacology Unit, Hospital del Mar Medical Research Institute-IMIM, Barcelona, Spain.
Lack of knowledge concerning the nature of placebo and why it is necessary may influence the participation of patients in clinical trials. The objective of the present study is to review how placebo is described in written information for participants in clinical trials to be evaluated by a Human Research Ethics Committee.
All research protocols submitted for evaluation in a Spanish hospital during 2007-2013 were reviewed. The main characteristics of the studies using a placebo were collected. Three authors read each of them to determine how the term "placebo" was explained and if there was any comment on its efficacy and safety.
Two thousand seven-hundred and forty research protocols were evaluated, of which three hundred and fifty-nine used a placebo. Pharmaceutical companies sponsored most placebo-controlled clinical trials (91.9%), and phase III studies were the commonest (59.9%). Oncology (15.0%), cardiology (14.2%), and neurology (13.1%) made the greatest contributions. A review of the informed consent forms showed that placebo was described in a similar manner in most studies: the explanation was limited to between four and eight words. Very few gave information about the risks of its use or adverse reactions from its administration. None of the studies provided details about the placebo effect. And 23 lacked any information about placebo at all.
Explanations about placebo in informed consent forms is often scarce, and information about the placebo effect and associated risks are absent. This situation may influence a full understanding of placebo by participants in clinical trials and might reduce their informed decision to participate.
1aUniversity of Toronto bToronto Western Hospital, Toronto, Ontario, Canada.
PURPOSE OF REVIEW:
The current article defines and surveys E-health: Internet and technology-guided interventions and tools useful for mood disorders.
E-health encompasses many categories, including computerized self-help strategies, online psychotherapy, websites that provide information, social media approaches including Facebook, Internet forums for health discussions, personal blogs, and videogames. Multiple tools exist to assess and document symptoms, particularly mood charts. Although all of these approaches are popular, only online psychotherapy and videogames have actually been evaluated in studies to evaluate both validity and efficacy. The face validity of social communication strategies including social media and blogs is strong, with clear implications for stigma reduction and peer support. Informational websites continue to be primary sources of psychoeducation on mental disorders. Social media sites have widespread use by the public and a profusion of health discussions and tools, but without published research evaluation of efficacy.
E-health strategies, particularly online psychotherapy and tools to document symptoms, are useful and likely effective. Social communication strategies show enormous popularity, but urgently require research evaluation for impact.
1Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts.
2Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts3Massachusetts General Hospital, Boston4National Bureau of Economic Research, Cambridge, Massachusetts.
3Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts4National Bureau of Economic Research, Cambridge, Massachusetts5Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts6Harvard Kenne.
4Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
Most out-of-hospital cardiac arrests receiving emergency medical services in the United States are treated by ambulance service providers trained in advanced life support (ALS), but supporting evidence for the use of ALS over basic life support (BLS) is limited.
To compare the effects of BLS and ALS on outcomes after out-of-hospital cardiac arrest.
DESIGN, SETTING, AND PARTICIPANTS:
Observational cohort study of a nationally representative sample of traditional Medicare beneficiaries from nonrural counties who experienced out-of-hospital cardiac arrest between January 1, 2009, and October 2, 2011, and for whom ALS or BLS ambulance services were billed to Medicare (31 292 ALS cases and 1643 BLS cases). Propensity score methods were used to compare the effects of ALS and BLS on patient survival, neurological performance, and medical spending after cardiac arrest.
MAIN OUTCOMES AND MEASURES:
Survival to hospital discharge, to 30 days, and to 90 days; neurological performance; and incremental medical spending per additional survivor to 1 year.
Survival to hospital discharge was greater among patients receiving BLS (13.1% vs 9.2% for ALS; 4.0 [95% CI, 2.3-5.7] percentage point difference), as was survival to 90 days (8.0% vs 5.4% for ALS; 2.6 [95% CI, 1.2-4.0] percentage point difference). Basic life support was associated with better neurological functioning among hospitalized patients (21.8% vs 44.8% with poor neurological functioning for ALS; 23.0 [95% CI, 18.6-27.4] percentage point difference). Incremental medical spending per additional survivor to 1 year for BLS relative to ALS was $154 333.
CONCLUSIONS AND RELEVANCE:
Patients with out-of-hospital cardiac arrest who received BLS had higher survival at hospital discharge and at 90 days compared with those who received ALS and were less likely to experience poor neurological functioning.
1Department of Tumor Biology, University Medical Center , Hamburg, Germany.
2Laboratory of Rare Human Circulating Cells, Department of Cellular and Tissular Biopathology, Cell and Tissue Biopathology of Tumors Department, Institute of Research in Biotherapy, University Medical Centre, Saint-Eloi Hospital , Montpellier, France ; University Institute of Clinical Research, University Montpellier 1-Epidemiology, Biostatistics and Public Health , Montpellier, France.
Besides circulating tumor cells, disseminated tumor cells (DTCs) in bone marrow (BM) might be used as a 'liquid biopsy' to obtain information helpful to steer therapies in individual patients. Moreover, the molecular characterization of DTCs may provide important insight into the biology of cancermetastasis. BM is a frequent site of metastasis in breast, prostate and lung cancer, and it might represent a sanctuary site for DTCs derived from various additional types of epithelial tumors. Highly sensitive and specific immunocytological and molecular methods enable the detection of DTCs in BM of cancer patients at the single-cell level years before the occurrence of metastases. This information might be useful to assess individual prognosis and stratify patients at risk to systemic adjuvant anti-cancer therapies. Although most data on the prognostic value of DTCs are available for breast cancer, several single institution studies including patients with colon, lung, prostate, esophageal, gastric, pancreatic, ovarian and head and neck carcinomas have also documented an association between the presence of DTCs at primary surgery and subsequent metastatic relapse. Most DTCs are in a dormant (that is, non-proliferative) stage, frequently express HER2 and display a cancer stem cell and immune escape phenotype. Here, we summarize the current knowledge about specific biological properties of DTCs in BM, and discuss the clinical relevance of DTC detection in cancer patients with regard to an improved individualized therapeutic management. This will stimulate further technical developments that may make BM sampling more acceptable for the clinical management of patients with solid tumors.
1School of Interactive Computing, Georgia Institute of Technology, Atlanta, Georgia, United States of America.
2School of Computer Science, University of Massachusetts, Amherst, Massachusetts, United States of America.
3School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America.
Computer-mediated communication is driving fundamental changes in the nature of written language. We investigate these changes by statistical analysis of a dataset comprising 107 million Twitter messages (authored by 2.7 million unique user accounts). Using a latent vector autoregressive model to aggregate across thousands of words, we identify high-level patterns in diffusion of linguistic change over the United States. Our model is robust to unpredictable changes in Twitter's sampling rate, and provides a probabilistic characterization of the relationship of macro-scale linguistic influence to a set of demographic and geographic predictors. The results of this analysis offer support for prior arguments that focus on geographical proximity and population size. However, demographic similarity - especially with regard to race - plays an even more central role, as cities with similar racial demographics are far more likely to share linguistic influence. Rather than moving towards a single unified "netspeak" dialect, language evolution in computer-mediated communication reproduces existing fault lines in spoken American English.
The NotCompatible virus has been working since 2012 but is in its third incarnation, Linden said. It now uses "end-to-end encryption, peer-to-peer networking technologies" and avoids being detected and removed. It's the perfect formula to create a network "rented out to any crime group," BBC News reported.
The scams generally mean that the phones are used to spew spam, scalp tickets and attack blogs. "This is the most technically sophisticated threat we are facing and it's the most worrying to us," said Mr Linden.
"Some overweight cancer patients who also have well-developed musculature will have a good prognosis, but those with excess fat and muscle loss, called ‘sarcopenia,’ generally have a very poor prognosis, Gioulbasanis said.
Most of the undernourished obese people in this study probably had sarcopenic obesity, he said."
"Obese children are at an increased risk for nonalcoholic fatty liver disease, hypertension and heart problems. High blood pressure and nonalcoholic fatty liver disease (NAFLD) is one of the emerging health problems with regard to the childhood obesity epidemic.
In this disease, improper storage of droplets of fat inside liver cells takes place. It affects nearly 10% of children in America. Overweight children and teenagers majorly get affected by the disease. It is the most common cause of chronic liver disease in the US."
Wireless smart meters (WSMs) promise numerous environmental benefits, but they have been installed without full consideration of public acceptance issues. Although societal-implications research and regulatory policy have focused on privacy, security, and accuracy issues, our research indicates that health concerns have played an important role in the public policy debates that have emerged in California. Regulatory bodies do not recognize non-thermal health effects for non-ionizing electromagnetic radiation, but both homeowners and counter-experts have contested the official assurances that WSMs pose no health risks. Similarities and differences with the existing social science literature on mobile phone masts are discussed, as are the broader political implications of framing an alternative policy based on an opt-out choice. The research suggests conditions under which health-oriented precautionary politics can be particularly effective, namely, if there is a mandatory technology, a network of counter-experts, and a broader context of democratic contestation.
To analyse national data on asbestos use and related diseases in the European Region of the World Health Organization (WHO).
For each of the 53 countries, per capita asbestos use (kg/capita/year) and age-adjusted mortality rates (deaths/million persons/year) due to mesothelioma and asbestosis were calculated using the databases of the United States Geological Survey and WHO, respectively. Countries were further categorized by ban status: early-ban (ban adopted by 2000, n = 17), late-ban (ban adopted 2001-2013, n = 17), and no-ban (n = 19).
Between 1920-2012, the highest per capita asbestos use was found in the no-ban group. After 2000, early-ban and late-ban groups reduced their asbestos use levels to less than or equal to 0.1 kg/capita/year, respectively, while the no-ban group maintained a very high use at 2.2 kg/capita/year. Between 1994 and 2010, the European Region registered 106 180 deaths from mesothelioma and asbestosis, accounting for 60% of such deaths worldwide. In the early-ban and late-ban groups, 16/17 and 15/17 countries, respectively, reported mesothelioma data to WHO, while only 6/19 countries in the no-ban group reported such data. The age-adjusted mortality rates for mesothelioma for the early-ban, late-ban and no-ban groups were 9.4, 3.7 and 3.2 deaths/million persons/year, respectively. Asbestosis rates for the groups were 0.8, 0.9 and 1.5 deaths/million persons/year, respectively.
Within the European Region, the early-ban countries reported most of the current asbestos-related deaths. However, this might shift to the no-ban countries, since the disease burden will likely increase in these countries due the heavy use of asbestos.